Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain

Zachary L. McCormick, Heejung Choi, Rajiv Reddy, Raafay H. Syed, Meghan Bhave, Mark C. Kendall, Dost Mohammad Khan, Geeta Nagpal, Masaru Teramoto, David R Walega

Research output: Contribution to journalArticle

Abstract

Background and objectives No previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain. Methods In this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of responders' (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change. Results Forty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21). Conclusions When using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant. Trial registration number NCT02478437.

Original languageEnglish (US)
Pages (from-to)389-397
Number of pages9
JournalRegional anesthesia and pain medicine
Volume44
Issue number3
DOIs
StatePublished - Mar 1 2019

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Zygapophyseal Joint
Arthralgia
Pain
Nerve Block
Psychometrics
Therapeutics
Demography
CI 22

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

McCormick, Zachary L. ; Choi, Heejung ; Reddy, Rajiv ; Syed, Raafay H. ; Bhave, Meghan ; Kendall, Mark C. ; Khan, Dost Mohammad ; Nagpal, Geeta ; Teramoto, Masaru ; Walega, David R. / Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain. In: Regional anesthesia and pain medicine. 2019 ; Vol. 44, No. 3. pp. 389-397.
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abstract = "Background and objectives No previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain. Methods In this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75{\%} relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of responders' (≥50{\%} Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change. Results Forty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50{\%} NRS reduction was observed in 52{\%} (95{\%} CI 31{\%} to 74{\%}) and 44{\%} (95{\%} CI 22{\%} to 69{\%}) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30{\%} reduction in ODI score was observed in 62{\%} (95{\%} CI 38{\%} to 82{\%}) and 44{\%} (95{\%} CI 22{\%} to 69{\%}) of participants in the C-RFA and T-RFA groups, respectively (p=0.21). Conclusions When using a single diagnostic block paradigm with a threshold of >75{\%} pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50{\%} when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant. Trial registration number NCT02478437.",
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Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain. / McCormick, Zachary L.; Choi, Heejung; Reddy, Rajiv; Syed, Raafay H.; Bhave, Meghan; Kendall, Mark C.; Khan, Dost Mohammad; Nagpal, Geeta; Teramoto, Masaru; Walega, David R.

In: Regional anesthesia and pain medicine, Vol. 44, No. 3, 01.03.2019, p. 389-397.

Research output: Contribution to journalArticle

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T1 - Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain

AU - McCormick, Zachary L.

AU - Choi, Heejung

AU - Reddy, Rajiv

AU - Syed, Raafay H.

AU - Bhave, Meghan

AU - Kendall, Mark C.

AU - Khan, Dost Mohammad

AU - Nagpal, Geeta

AU - Teramoto, Masaru

AU - Walega, David R

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N2 - Background and objectives No previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain. Methods In this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of responders' (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change. Results Forty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21). Conclusions When using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant. Trial registration number NCT02478437.

AB - Background and objectives No previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain. Methods In this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of responders' (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change. Results Forty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21). Conclusions When using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant. Trial registration number NCT02478437.

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